UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin 4, Ireland.
BMC Health Serv Res. 2020 Feb 10;20(1):101. doi: 10.1186/s12913-020-4931-2.
Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions.
A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.
Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions' ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours.
To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams.
CRD42018100659.
拥有具有心理安全感的团队可以提高组织内的学习、创造力和绩效。在医疗保健环境中，心理安全通过支持质量改进和鼓励员工就错误发表意见来支持患者安全。尽管医疗团队的心理安全水平较低，并且它在支持患者安全方面发挥着重要作用，但关于可以用来提高心理安全或其相关结构的干预措施的研究却很少。本综述综合了针对医疗保健环境中的心理安全、直言不讳和发声行为的干预措施的内容、理论基础和结果。其目的是确定成功的干预措施，并为开发更有效的干预措施提供信息。
制定并使用关键字搜索策略在电子数据库（PsycINFO、ABI/Inform、Academic Search Complete 和 PubMed）和灰色文献数据库（OpenGrey、OCLC WorldCat、Espace）中进行搜索。使用在线专业系统评价网站 Covidence 筛选记录。对确定的论文进行数据提取、质量评估和叙述性综合。
共审查了 14 项干预措施。这些干预措施分为五类。教育干预措施使用模拟、视频演示、案例研究和讲习班，而不包括教育部分的干预措施则使用整体促进、论坛游戏和行动研究会议。这些干预措施的效果或有效性的结果好坏参半。虽然一些干预措施显示与心理安全、直言不讳和发声相关的结果有所改善，但并非所有干预措施都一致。所纳入的干预措施在改善这些结果方面的能力受到缺乏客观结果衡量标准以及教育干预措施单独改变根深蒂固的直言不讳行为的能力的限制。
为了提高我们对针对心理安全感、直言不讳和发声行为的干预措施的效果或有效性的理解，需要进行纵向和多方面的干预措施。为了了解这些干预措施是否成功，应该开发更客观的衡量标准。建议未来的研究让最终用户参与干预措施的设计阶段，针对团体和组织层面，确保可见的领导支持，并在跨学科团队内和团队之间开展工作。
PROSPERO 注册号：CRD42018100659。
Zotero 插件